Associations between IVF outcomes and essential trace elements measured in follicular fluid and urine: a pilot study

Purpose

A hypothesis-generating pilot study exploring associations between essential trace elements measured in follicular fluid (FF) and urine and in vitro fertilization (IVF) endpoints.

Methods

We recruited 58 women undergoing IVF between 2007 and 2008, and measured cobalt, chromium, copper, manganese, molybdenum, and zinc in FF (n?=?46) and urine (n?=?45) by inductively coupled plasma mass spectrometry (ICP-MS). We used multivariable regression models to assess the impact of FF and urine trace elements on IVF outcomes, adjusted for age, body mass index, race, and cigarette smoking.

Results

Trace elements were mostly present at lower concentrations in FF than in urine. The average number of oocytes retrieved was positively associated with higher urine cobalt, chromium, copper, and molybdenum concentrations. FF chromium and manganese were negatively associated with the proportion of mature oocytes, yet urine manganese had a positive association. FF zinc was inversely associated with average oocyte fertilization. Urine trace elements were significant positive predictors for the total number of embryos generated. FF copper predicted lower embryo fragmentation while urine copper was associated with higher embryo cell number and urine manganese with higher embryo fragmentation. No associations were detected for implantation, pregnancy, or live birth.

Conclusions

Our results suggest the importance of trace elements in both FF and urine for intermediate, although not necessarily clinical, IVF endpoints. The results differed using FF or urine biomarkers of exposure, which may have implications for the design of clinical and epidemiologic investigations. These initial findings will form the basis of a more definitive future study.

     

Prospective Measurement of Daily Health Behaviors: Modeling Temporal Patterns in Missing Data,Sexual Behavior,and Substance Use in an Online Daily Diary Study of Gay and Bisexual Men

Daily diary and other intensive longitudinal methods are increasingly being used to investigate fluctuations in psychological and behavioral processes. To inform the development of this methodology, we sought to explore predictors of and patterns in diary compliance and behavioral reports. We used multilevel modeling to analyze data from an online daily diary study of 371 gay and bisexual men focused on sexual behavior and substance use. We found that greater education and older age as well as lower frequency of substance use were associated with higher compliance. Using polynomial and trigonometric functions, we found evidence for circaseptan patterns in compliance, sexual behavior, and substance use, as well as linear declines in compliance and behavior over time. The results suggest potential sources of non-random patterns of missing data and suggest that trigonometric terms provide a similar but more parsimonious investigation of circaseptan rhythms than do third-order polynomial terms.     

Effective strategies for forensic analysis in the mitochondrial DNA coding region

Recently, it has been recognized that accessing information in the mtDNA coding region can provide additional forensic discrimination with respect to the standard typing of the D-loop region, augmenting the sometimes rather limited forensic power of mtDNA testing. Here, we discuss considerations relating to maximally effective approaches for recovering additional discrimination in the coding region, bearing in mind that (1) DNA quality and quantity in typical mtDNA casework usually restrict the amount of additional sequence that can be obtained, and (2) the need for additional discrimination primarily arises when common HV1/HV2 types are encountered. Most investigators have sought additional discrimination by sequencing short segments of coding region that are thought to be particularly variable. Unfortunately, efforts in this regard have generally failed to appreciate that most variation in the coding region is redundant with information already present in HV1/HV2 and have therefore overvalued the potential of this approach for providing additional discrimination. An alternative single nucleotide polymorphism-based approach [Int J Legal Med 118:137-146, 2004] has been to identify specific bases that provide resolution in specific common HV1/HV2 types (and related sequences). We investigate several highly relevant data sets wherein the latter approach performs appreciably better than sequencing selected short portions of the coding region. This is true even when only synonymous variation is targeted to minimize the potential for problems arising from discovery of mutations that have reportedly been related to disease.     

Perpetrators of homicide with schizophrenia: a national clinical survey in England and Wales

OBJECTIVE: Few studies have described rates of schizophrenia in a national sample of homicide perpetrators. This study aimed to describe this group's social and clinical characteristics, mental state features, offense details, and outcome in court. METHOD: Analyses used a national clinical survey that collected data on people convicted of homicide in England and Wales (1996-1999). Data were collected for those with schizophrenia or other delusional disorders from psychiatric reports and questionnaires. RESULTS: Of the 1,594 people convicted of homicide, 85 (5 percent) had schizophrenia. Of the 57 people with schizophrenia for whom data were available, 32 (56 percent) had been ill for less than 12 months, and in the month before the offense, 32 (56 percent) had shown a change in the quality, intensity, or conviction of or emotional response to their delusional beliefs. Twenty-four (28 percent) had no previous contact with psychiatric services. CONCLUSIONS: Regular assessment of delusions may help to detect an increased risk of violence, including homicide. More intensive care should be available for patients with a history of schizophrenia and previous violence.     

Fellows' Journal Club: Hyperintense Optic Nerve Heads on Diffusion-Weighted Imaging: A Potential Imaging Sign of Papilledema

BACKGROUND AND PURPOSE:Changes at the optic nerve head on DWI in the presence of papilledema have not been systematically studied. The purpose of this study was to evaluate if hyperintensity of ON heads on DWI is associated with papilledema.MATERIALS AND METHODS:In this retrospective study, 19 patients (4 men, 15 women; median age, 32 years) with papilledema and 20 control participants (7 men, 13 women; median age, 48 years) who had undergone prior MR imaging of the brain were identified. Two neuroradiologists blinded to the diagnosis independently reviewed the DWI for the presence of hyperintense signal at the ON head of each eye. If present, they graded the signal as mild or prominent. Groups with and without papilledema were compared for the prevalence of ON head hyperintensity by using the Fisher exact test, with analyses performed both for groups of patients and for individual eyes. Presence of ON head hyperintensity was also studied as a function of Frisen papilledema grade on fundoscopy, when available.RESULTS:Hyperintensity of the ON heads on DWI was significantly associated with papilledema (P = .001). For the 2 readers, hyperintensity at both ON heads was 26.3% and 42.1% sensitive and 100% specific in the detection of papilledema. The presence of unilateral ON head hyperintensity was not specific for papilledema and was invariably graded as mild when seen in the control group. Patients with higher papilledema grades had a higher prevalence of hyperintensity at the ON heads.CONCLUSIONS:Hyperintensity of the ON heads on DWI can serve as a useful imaging marker for papilledema, especially if bilateral. Its absence, however, does not exclude papilledema.

Papilledema is defined as swelling of the optic disc secondary to increased intracranial pressure, often occurring in the setting of intracranial space-occupying lesions, intracranial inflammation, venous sinus thrombosis, hydrocephalus, and idiopathic intracranial hypertension (pseudotumor cerebri).^1–3 Although MR imaging is primarily used in an attempt to elucidate the cause of the papilledema, MR imaging may, at times, provide the first indication of underlying papilledema, particularly in those patients with headache in whom fundoscopic examination has not yet been performed or has not been able to detect papilledema given its less-than-perfect sensitivity because of factors such as patient cooperation and examiner skill.^4,5 This ability of MR imaging to identify otherwise unsuspected papilledema is especially important in patients with idiopathic intracranial hypertension, in whom the diagnosis often hinges on the recognition of papilledema.Several signs relating to papilledema have been described on MR imaging, including flattening of the posterior sclera, intraocular protrusion of the prelaminar ON, orbital ON tortuosity, distention of the perioptic subarachnoid space with fluid, prelaminar ON enhancement with gadolinium, and empty sella. Although these signs have been found to be present in affected patients, the reported sensitivity and specificity of the signs are variable. Although some studies have indicated that MR imaging can identify papilledema with sensitivity and specificity of more than 90%, other studies have indicated that almost all of these signs (with the exception of altered globe configuration at the ON head) may be observed in control participants, making them nonspecific.^6–8 An additional imaging sign of papilledema could improve the diagnostic ability of MR imaging in patients with headache. We have anecdotally observed hyperintensity of the ON head on DWI in some cases of clinically proven papilledema. Although this has been previously described in a case report,² the ability of this sign to distinguish patients with papilledema from healthy control participants has not been systematically studied.The purpose of this study is to evaluate whether hyperintensity of the ON head on DWI is statistically more likely to occur in patients with clinically proven papilledema than in unaffected control participants.     

Assessment without action; a randomised evaluation of the interRAI home care compared to a national assessment tool on identification of needs and service provision for older people in New Zealand

Comprehensive geriatric assessment (CGA) is considered the cornerstone of good practice, as it identifies need across multiple domains such as social, physical and psychological. The interRAI home care (interRAI‐HC), probably the most well‐researched and supported community‐based CGA has been implemented globally, often at considerable expense. Policy‐makers, managers and clinicians anticipate significant gains in health outcomes following such investment; however, the implementation of CGA is often undertaken in the absence of community service development. This study sought to compare the interRAI‐HC with an existing CGA [the Support Needs Assessment (SNA)] in community‐dwelling older people. A randomised controlled trial was undertaken from January 2006 to January 2007 comparing the interRAI‐HC and the SNA in 316 people (65+) referred for assessment of needs with follow‐up at 1 and 4 months. Outcomes included health‐related quality of life, physical function, social support, cognitive status, mood and health service usage as well as identified need. The study found that significantly more support needs were identified using the interRAI‐HC compared to the SNA. More social and carer support were recommended by SNA and more rehabilitation and preventive health screens were recommended by interRAI‐HC. Despite these differences, the mean healthcare use was similar at 4 months, although interRAI‐HC participants had more Emergency Department presentations and hospital admissions. No statistically significant differences between groups were reported in terms of outcomes. In conclusion, the interRAI‐HC was found to identify more unmet support needs than the SNA though resulted in no favourable outcomes for the older person or their carer. The study highlights the need to invest attention around the service context to maximise outcomes based on identified needs.     

Proportional‐odds models for repeated composite and long ordinal outcome scales

In many medical studies, researchers widely use composite or long ordinal scores, that is, scores that have a large number of categories and a natural ordering often resulting from the sum of a number of short ordinal scores, to assess function or quality of life. Typically, we analyse these using unjustified assumptions of normality for the outcome measure, which are unlikely to be even approximately true. Scores of this type are better analysed using methods reserved for more conventional (short) ordinal scores, such as the proportional‐odds model. We can avoid the need for a large number of cut‐point parameters that define the divisions between the score categories for long ordinal scores in the proportional‐odds model by the inclusion of orthogonal polynomial contrasts. We introduce the repeated measures proportional‐odds logistic regression model and describe for long ordinal outcomes modifications to the generalized estimating equation methodology used for parameter estimation. We introduce data from a trial assessing two surgical interventions, briefly describe and re‐analyse these using the new model and compare inferences from the new analysis with previously published results for the primary outcome measure (hip function at 12 months postoperatively). We use a simulation study to illustrate how this model also has more general application for conventional short ordinal scores, to select amongst competing models of varying complexity for the cut‐point parameters. Copyright © 2013 John Wiley & Sons, Ltd.     

Community Engagement and Data Disclosure in Environmental Health Research

Summary: Federal funding agencies increasingly support stakeholder participation in environmental health studies, and yet there is very little published research on engagement of community members in the development of data disclosure (DD) strategies. The Ohio Environmental Protection Agency reported airborne manganese (Mn) concentrations in East Liverpool, Ohio, 30 times higher than the reference concentration, which led to an academic–community research partnership to address community concern about Mn exposure, particularly among children. Children and their families were recruited to participate in a pilot study. Samples of blood and hair were collected from the children and analyzed for metals. DD mechanisms were developed using an iterative approach between community and academic partners. Individual DD letters were mailed to each participating family, and a community meeting was held. A post-meeting survey was administered to gauge community perception of the DD strategies. The purpose of this article is to demonstrate the effectiveness of engaging community partners in the conduct of environmental health research and in the development of DD strategies for individuals and the community at large. Scientists should include community partners in the development of DD strategies to enhance translation of the research findings and support the right of study participants to know their individual results.     

Parental smoking practices and caries experience in pre-school children

Voluntary and involuntary smoking influence general health. Links between voluntary smoking and oral health are confirmed for periodontal diseases and oral cancer/precancer. Since recent reports have suggested an association between parental smoking and caries experience in young children, this study aimed to explore varying patterns of parental smoking, adjusted for social class, with caries prevalence, using data derived from the UK National Diet and Nutrition Survey (1995). Data analysis was confined to 749 children aged 3.0-4.5 years, to avoid confounding effects of unerupted teeth. Bivariate analysis indicated that the prevalence of maternal rather than paternal smoking was significantly related to caries and substantially attenuated social class differences. The reported number of cigarettes smoked was not important. To compensate for the association between social class and maternal smoking, data were dichotomised by social class (manual/non-manual). With caries prevalence as the dependent variable, logistic regression analysis recorded maternal smoking as a significant independent variable in each case, with odds ratios of 1.55/1.96, respectively. The process was repeated for the combined dataset, using the more extensive (six) social class categories. This further analysis yielded an odds ratio for maternal smoking of 1.54 compared with 1.46 for social class. Nutrition status (as growth parameters) and dietary intake (as household spending on confectionery) were not significant independent variables in these equations. The rationale for these findings is discussed. Further research is required to determine mechanisms underlying these observations. It is concluded that maternal smoking is a significant factor to be considered as an additional risk indicator beyond social class when predicting caries risk in young children.